Simultaneously Improved Pulmonary and Cardiovascular Autonomic Function and Short-Term Functional Outcomes in Patients with Parkinson’s Disease after Respiratory Muscle Training

Chih-Cheng Huang,Nai-Ying Kuo,Cheng-Hsien Lu,Yun-Ru Lai,Yuh-Chyn Tsai,Nai-Wen Tsai,Fu-An Wu,Ben-Chung Cheng

doi:10.3390/jcm9020316

Abstract

Both pulmonary function and autonomic function are impaired in patients with Parkinson’s diseases (PD). This study tested the hypothesis that respiratory muscle training (RMT) can not only improve pulmonary function, but also simultaneously improve cardiovascular autonomic function and short-term functional outcomes in patients with PD. Pulmonary function was measured by the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum inspiratory pressures (MIP), and maximum expiratory pressures (MEP). Cardiovascular autonomic function was measured by the heart rate response to deep breathing (HRDB), Valsalva ratio, baroreflex sensitivity, and spectral analysis. The functional and severity scores were measured by the Hoehn and Yahr stage and Unified Parkinson’s Disease Rating Scale (UPDRS). These measures were evaluated in patients with PD before and after 3 months of RMT, compared with a control group of PD patients without RMT. The results showed significant improvement of clinical scores (total UPDRS and UPDRS I, II and III) after RMT (p < 0.0001). Concerning pulmonary function, the parameters of MIP and MEP improved significantly. The parameters of cardiovascular function also improved after RMT, although only HRDB reached statistical significance. Based on the results of our study, RMT can not only improve both pulmonary and cardiovascular autonomic function, but can also improve short-term functional outcomes in patients with PD.

Highlights

Parkinson’s disease (PD) is a progressive neurodegenerative disorder which manifests through a broad spectrum of motor and non-motor symptoms [1,2]
We propose the hypotheses that respiratory muscle training (RMT) for patients with PD can improve respiratory function, and improve cardiovascular autonomic function and their functional outcomes as well
There was no significant difference between the two groups in terms of age, sex, body mass index (BMI), duration of disease, levodopa-equivalent dose (LED), or disease severity scale

Summary

Introduction

Parkinson’s disease (PD) is a progressive neurodegenerative disorder which manifests through a broad spectrum of motor and non-motor symptoms [1,2]. Impaired pulmonary function usually goes unnoticed until in the advanced stages of the disease [3,4,5]. Autonomic disorders have been recognized as an important non-motor feature of PD [6,7]. It has been recognized that the autonomic nervous system plays a pivotal role in the regulation of lung ventilation, gas exchange, and airway smooth muscle function [8]. The observation that levodopa has a limited impact on the improvement of pulmonary function may suggest that respiration is associated with motor function, which is mediated mainly by a dopaminergic system, and with other networks [9,10,11,12,13,14]

Methods

Results

Conclusion